About a year ago, my doctor and I discussed a surgical procedure that would alleviate some issues I have had over the past couple of years. Our discussion did not center on my well being as a patient, although that was the ultimate goal. Rather, it revolved around the cost associated with the surgery and whether or not health insurance would cover it. Unfortunately, this was not my first conversation with a health care provider regarding health insurance and probably won’t be my last. I have gone from having no health insurance coverage, while in college, to having a major HMO plan when I worked for a large corporation, to being covered, sporadically, while being self-employed. Moreover, medical insurance has become a necessity these days. You should also know how mental health problems can affect insurance cover which is why keeping yourself mentally and physically healthy is really important.
After being married a few years, my husband and I learned the difference between insurance paid health costs and those costs paid, out-of-pocket. This happened when my doctor confirmed we would be having our first child. We were very excited even as we were directed to the doctor’s billing office to arrange payment. We were asked if we had health insurance. We did, indeed, have health insurance, but had learned that it did not cover maternity costs. We were told our cost to the doctor, especially if paid up-front, would be much less than if our insurance had covered it anyway. What we learned was that doctors and hospitals charge a much higher rate for those covered by insurance due to the extra costs they incur in having to deal with health insurance companies in the first place! We were shocked by this but were glad that our payment made that day was lower than it would have been had we actually had coverage. About a week later, we visited the hospital for a tour of the maternity unit and paid them for their upcoming services too.
Approximately eight months later, our baby girl was born via emergency surgery. After returning home, I received a bill from the hospital for around ten thousand dollars. I also got an extra bill from my doctor as well. I was devastated. We had just brought home our newborn baby and what should have been a joyous time, became a very stressful one. However, we quickly paid the doctor for his additional services and I began making monthly payments to the hospital. I was told that since emergency surgery was performed, that our insurance may end up paying part of the bill. I contacted our insurance company and they said, no.
Six busy months with our daughter had quickly passed when I got a call from the hospital. The lady on the other end of the phone said, “I see you have been making payments to us for a while.” Then she laughed and said, “With the rate, you’re going, this bill will take forever to pay off! We were mistaken in billing you as much as we did. You really only owe fifteen hundred dollars. Would you like to put that on a credit card?” She went on to tell me that they had inadvertently billed me the hospital’s “insurance rate”. I was relieved that I didn’t owe the larger amount, but it made me realize just how much the cost of healthcare was inflated due to the involvement of health insurance companies.
Being self-employed now, we have tried individual health insurance plans and they simply do not work. What I have found is, the monthly premiums start out at a somewhat reasonable rate, but they eventually increase dramatically in price after about a year. When we try to use the coverage for nothing more than a doctor’s visit, we are billed the insurance rate. That rate can result in much more money owed than if we had simply paid out-of-pocket in the first place. My experience with health insurance companies is that they have added a tremendous amount of cost and complexity to something very personal. When a doctor and their patient have to be concerned with the price of a procedure, rather than the well-being of the patient, it’s evident that the insurance companies have taken the care out of healthcare.
